Case-based Reasoning

This chapter presents a solution to the integration problem. EBM, the dominant approach to medical knowledge, focuses on the importance of clinical trials in providing medical knowledge. Other chapters in this book have argued for the importance of including knowledge of physiological mechanisms, a provider’s clinical experience, and understanding of patient experiences and values to clinical decision-making. The importance of all of these sources of medical knowledge makes solving the integration problem even more crucial. This chapter offers a solution to this problem that is rooted in case-based reasoning. It begins by describing the basic components of case-based reasoning, including construction of a target case and reasoning by analogy between that target case and one or more source cases. It then introduces a more detailed model of clinical reasoning that is based on Stephen Toulmin’s model of argumentation, and that allows clinicians to integrate the different kinds of knowledge in a way that responds to the needs of specific patients in specific situations. Using this model can help clinicians better understand their own reasoning—and better communicate that reasoning to trainees, colleagues, and patients. The case-based framework represents an explicit and practicable method integrate a plurality of medical knowledge into a particular medical decision.